Table 1
The five domains and 22 subdomains of essential ELC education composed of criteria formulated by Barnard et al. [7] and Emanuel et al. [17]
|
Domain 1: Psychological, sociological, cultural and spiritual aspects |
Suffering |
|
Loss | |
|
Mourning | |
|
Rituals and meaning at the end of life | |
|
Domain 2: Communication and conversational techniques |
Listening to the impact of disease on the patient’s life |
|
Explore hope, helplessness and fear in depth | |
|
Discuss loss and mourning | |
|
Discuss spiritual considerations | |
|
Discuss advanced care planning | |
|
Domain 3: Pathophysiology and treatment of symptoms |
Pain |
|
Dyspnoea | |
|
Dehydration | |
|
Depression | |
|
Delirium | |
|
Fear | |
|
Domain 4: Juridical and ethical aspects |
Not-starting/stopping treatment and euthanasia |
|
Dilemmas on the treatment of pain | |
|
Non-abandonment of the patient | |
|
Domain 5: Self-reflection on personal and professional experiences with death and loss |
Personal experience with death |
|
View on the hereafter | |
|
Goals of medicine | |
|
Role of the doctor and other health workers in ELC |
Table 2
The presence of the five domains of end-of-life care (ELC) in the Dutch national blueprint for medical education
|
End terms national blueprint | |
|---|---|
|
Domain 1 Psychological, sociological, cultural and spiritual aspects of death and dying |
– |
|
Domain 2 Communication and conversational techniques regarding ELC |
6.2.2.4. After the bad news conversation, the young doctor is able to guide and support the patient and his loved ones adequately. 6.2.2.4. To guide and support the chronically and the terminally ill in palliative care |
|
Domain 3 Pathophysiology and treatment of symptoms in ELC |
7.2.4.5. After the master program, the young doctor has knowledge about care for the terminally ill and the young doctor has knowledge about the dying process and about determining the cause of death. 8.3.1.2.4. After the bachelor program, the student has knowledge on the conception and development, growth and sexual maturation, and ageing and dying of an organism. 9.2.2.5. After the master program, the young doctor has knowledge on and insight in the conception, development, growth, sex maturation, ageing and dying process of an organism. 9.2.2.7. After the master program, the young doctor has knowledge on and insight in pathophysiology of the dying process and death of an organism |
|
Domain 4 Juridical and ethical aspects regarding ELC |
9.3.3.10. After the master program, the young doctor has knowledge on and insight in the principles of medical ethics and can deal with dilemmas such as induced abortion or euthanasia |
|
Domain 5 Self-reflection on personal and professional experiences with death and loss |
6.2.7.4. After the master program, the young doctor should have the competence to reflect on his/her own performance in difficult or moving situations. 6.2.7.4. After the master program, the young doctor should have the competence to recognize his/her own feelings and norms and values in relation to existential questions on life, death, disease and health |
Table 3
Education on end-of-life care in the Dutch medical curricula
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
B |
M |
B |
M |
B |
M |
B |
M |
B |
M |
B |
M |
B |
M |
B&M | |
|
Domain 1: Psychological, sociological, cultural and spiritual aspects | |||||||||||||||
|
Suffering |
○ |
○ |
● |
○ |
– |
○ |
● |
– |
○ |
● |
– |
● |
● |
n/a |
● |
|
Loss |
○ |
– |
○ |
○ |
– |
○ |
● |
– |
○ |
○ |
– |
– |
– |
″ |
● |
|
Mourning |
○ |
– |
○ |
○ |
– |
○ |
● |
– |
○ |
○ |
– |
– |
+ |
″ |
● |
|
Rituals and meaning at the end of life |
– |
– |
● |
● |
– |
○ |
– |
– |
– |
– |
● |
– |
+ |
″ |
– |
|
Domain 2: Communication and conversational techniques | |||||||||||||||
|
Listening to the impact of disease on the patient’s life |
○ |
○ |
○ |
○ |
○ |
○ |
● |
○ |
○ |
○ |
● |
● |
″ |
● | |
|
Explore hope, helplessness and fear in depth |
○ |
○ |
○ |
○ |
○ |
– |
– |
– |
– |
● |
– |
● |
– |
″ |
● |
|
Discuss loss and mourning |
○ |
– |
○ |
○ |
○ |
– |
● |
– |
– |
○ |
● |
– |
– |
″ |
● |
|
Discuss spiritual considerations |
– |
– |
○ |
– |
– |
– |
– |
– |
– |
– |
– |
● |
– |
″ |
● |
|
Discuss advanced care planning |
– |
○ |
○ |
○ |
○ |
– |
● |
– |
● |
● |
– |
● |
– |
″ |
○ |
|
Domain 3: Pathophysiology and treatment of symptoms | |||||||||||||||
|
Pain |
○ |
○ |
● |
○ |
○ |
○ |
● |
● |
● |
○ |
● |
● |
○ |
″ |
● |
|
Dyspnoea |
○ |
○ |
○ |
○ |
○ |
○ |
– |
○ |
○ |
○ |
○ |
● |
○ |
″ |
● |
|
Dehydration |
○ |
○ |
○ |
○ |
– |
○ |
○ |
○ |
○ |
– |
○ |
● |
○ |
″ |
● |
|
Depression |
– |
○ |
○ |
○ |
○ |
○ |
– |
○ |
● |
– |
● |
● |
○ |
″ |
○ |
|
Delirium |
– |
○ |
○ |
○ |
– |
○ |
● |
○ |
○ |
○ |
○ |
– |
○ |
″ |
○ |
|
Fear |
– |
○ |
○ |
○ |
○ |
○ |
– |
○ |
● |
– |
● |
– |
○ |
″ |
○ |
|
Domain 4: Juridical and ethical aspects | |||||||||||||||
|
Not-starting/stopping treatment and euthanasia |
○ |
○ |
● |
● |
○ |
○ |
● |
○ |
● |
○ |
● |
● |
● |
″ |
– |
|
Dilemmas on the treatment of pain |
○ |
○ |
○ |
● |
– |
○ |
● |
● |
+ |
○ |
– |
– |
+ |
″ |
– |
|
Non-abandonment of the patient |
– |
○ |
○ |
○ |
– |
– |
● |
○ |
○ |
– |
○ |
○ |
○ |
″ |
– |
|
Domain 5: Self-reflection on personal and professional experiences with death and loss | |||||||||||||||
|
Personal experience with death |
– |
– |
● |
● |
– |
○ |
● |
– |
– |
● |
● |
– |
– |
″ |
– |
|
View on the hereafter |
– |
– |
○ |
– |
– |
– |
– |
– |
– |
– |
– |
– |
– |
″ |
– |
|
Goals of medicine |
○ |
○ |
○ |
○ |
○ |
○ |
– |
– |
○ |
○ |
○ |
– |
○ |
○ |
○ |
|
Role of doctors and other health workers in ELC |
– |
○ |
○ |
○ |
– |
○ |
● |
– |
○ |
○ |
– |
● |
– |
″ |
○ |
● Interactive, ELC-specific education; working group, discussion group, practical sessions, + Passive, ELC-specific education; lectures, ○ Non-ELC-specific education; interwoven in courses, – No ELC-education, n/a Not available, 1 University Medical Center Utrecht, 2 VU University Medical Center, 3 University Medical Center Groningen, 4 Leiden University Medical Center, 5 Amsterdam University Medical Center, 6 Maastricht University Medical Center, 7 Erasmus University Medical Center, 8 St. Radboud University Medical Center, B bachelor, M master, n/a not available